MEDICARE: KENNETH M LEAVITT DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	1680	MA
2	213E00000X	Podiatrist	1680	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386672343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH M LEAVITT DPM

Provider Business Mailing Address
First Line	:	67 MILLBROOK ST.
Second Line	:	C/O CHM
City	:	WORCESTER
State	:	MA
Zip	:	01606-2835
Country	:	US
Telephone Number	:	508-795-0009
Fax Number	:	508-795-0393

Provider Business Practice Location Address
First Line	:	125 PARKER HILL AVE
Second Line	:	STE 390
City	:	BOSTON
State	:	MA
Zip	:	02120-2847
Country	:	US
Telephone Number	:	617-277-3800
Fax Number	:	617-277-3808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	03/02/2015

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Directions to “ KENNETH M LEAVITT DPM” Practice Location

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